Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Revenue Cycle Management Healthcare News

CMS Clarifies Site-Neutral Medicare Reimbursement Exceptions

by

With the site-neutral Medicare reimbursement policy taking effect on Jan. 1, CMS recently released guidance on what hospital departments qualify for exemption from the rule. The federal agency clarified expanded site-neutral payment exemption...

3 Most Common Healthcare Supply Chain Management Challenges

by

From gauze and paper gowns to implantable medical devices and prescription drugs, provider organizations must implement efficient healthcare supply chain management processes to cut overall costs and standardize care delivery. But for many organizations,...

OIG: NJ Agency Falsely Claimed $95M in Medicaid Reimbursement

by

New Jersey’s Department of Health and Human Services may have to repay the federal government almost $95 million after the Office of the Inspector General (OIG) recently found that the state agency received improper Medicaid reimbursement...

Flexibility Key to Revenue Cycle Management Vendor Selection

by

With thousands of healthcare revenue cycle management and business intelligence analytics vendors in the market, how does a provider organization decide on just one? According to Robert Creaven, CMPE, MPA, Executive Vice President of Operations...

What is the Medicare Shared Savings Program Track 1+ Model?

by

As the Quality Payment Program links more Medicare payments to value-based reimbursement, a new Medicare Shared Savings Program (MSSP) track will allow eligible clinicians to qualify for additional incentive payments in the program’s Advanced...

Net Medicare Improper Payment Recoveries Dropped 91% in 2015

by

Medicare improper payment recoveries saw a significant drop in 2015, according to a recent CMS report to Congress. The Recovery Audit Contractor (RAC) program returned 91 percent less to Medicare during the 2015 fiscal year compared to 2014....

OIG Finds Medicare Payment Problems with Two-Midnight Policy

by

Hospitals may face more Medicare reimbursement audits on inpatient and outpatient claims after the Office of the Inspector General (OIG) recently found several vulnerabilities associated with the Two-Midnight policy. Using hospital and provider...

Market Power, Not Quality Linked to Higher Healthcare Costs

by

Higher healthcare costs at New York hospitals are linked to increased market power and not higher quality of care, the New York State Health Foundation recently reported. More expensive hospitals tended to have increased market leverage, such...

How Social Risk Factors Influence Value-Based Reimbursement

by

Safety-net providers received more financial penalties under Medicare value-based reimbursement programs because the hospitals treated more beneficiaries with social risk factors, such as dual eligibility, low income, race, ethnicity, and rural...

AHA Asks CMS to Increase Site-Neutral Medicare Reimbursement

by

The American Hospital Association (AHA) recently advised CMS to increase Medicare reimbursement rates to off-campus provider-based outpatient departments that will be paid under site-neutral payment rules starting on Jan. 1, 2017. The industry...

OIG: Provider Support, Health IT Needed for MACRA Implementation

by

MACRA implementation has been a major priority for CMS in the past year, but the Department of Health and Human Service’s Office of the Inspector General (OIG) recently found several challenges that could impede Quality Payment Program...

Medicaid, Medicare Reimbursement $57.8B Below Hospital Costs

by

Medicaid and Medicare reimbursement in 2015 was under actual hospital costs for treating beneficiaries by $57.8 billion, the American Hospital Association (AHA) recently reported. According to data from the AHA’s Annual Survey of US Hospitals,...

URAC Calls for Virtual Group Rules in Quality Payment Program

by

URAC, a non-profit healthcare accreditation company, recently called on CMS to implement virtual group standards under the Quality Payment Program in 2018 that promote economies of scale for more activities than just reporting compliance. The...

Does Hospital Size Impact Value-Based Penalties in CMS Program?

by

Value-based penalties in the Medicare Hospital-Acquired Condition Reduction Program are disproportionately affected by a participating hospital’s bed size and number of cases, a recent American Journal of Medical Quality study indicated....

Payment Reform, Value-Based Care Top 2017 Medicaid Priorities

by

Delivery system and healthcare payment reform, especially through value-based care, topped the list of 2017 Medicaid priorities, according to the annual State Medicaid Operations Survey from the National Association of Medicaid Directors (NAMD)....

Unexpected Patient Financial Responsibility in 20% of ED Cases

by

Approximately 20 percent of hospital admissions stemming from an emergency department visit in 2014 led to unexpected patient financial responsibility in the form of surprise medical bills, a recent Health Affairs study reported. Using national...

CMS Unveils New Medicare APMs for Quality Payment Program

by

CMS finalized several new Medicare alternative payment models that will qualify for a five percent value-based incentive payment through the Quality Payment Program. The announcement contained bundled payment initiatives for cardiac and orthopedic...

AMGA: Drop Transition, Add MSSP Track for MACRA Implementation

by

With the Quality Payment Program set to launch on Jan. 1, 2017, the American Medical Group Association (AMGA) provided CMS with several MACRA implementation suggestions, including transition year elimination by 2018 and Medicare Shared Savings...

CMS Reveals Medicare-Medicaid Accountable Care Organization

by

CMS recently unveiled a Medicare-Medicaid accountable care organization (ACO) model that will allow participating providers in the Medicare Shared Savings Program to take on accountability for Medicaid costs and quality of care for dual-eligible...

PQRS Medicare Payment Adjustments Waived After ICD-10 Update

by

Some eligible professionals and group practices will not receive Physician Quality Reporting System (PQRS) Medicare payment adjustments in 2017 and 2018 because of the recent ICD-10 update, CMS recently announced in an email. The announcement...

Continue to site...